Mental Health, Employment and the Use of Sanctions: What the Evidence Tells Us

13/11/2015 11:46 GMT
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Updated
13/11/2016 10:12 GMT

The number of people with mental health problems being given benefit sanctions is rising rapidly, according to figures reported in The Independent this week.

In the same week, a call on the Government to review the impact of sanctions on people with mental health problems was refused, despite growing anecdotal evidence of the risks they can pose.

In the NHS, any clinical intervention for people with serious conditions such as anxiety, depression or psychosis is subject to rigorous testing before being made available. In the case of psychological therapies, extending access to treatments recommended by NICE has taken nearly a decade and is far from finished. And for NICE to recommend a procedure it has to have been subject to high quality testing, randomised controlled trials and the like. Patient safety, meanwhile, is a major concern, and any intervention known to have the potential to cause harm is carefully monitored and when necessary withdrawn.

When benefit sanctions were introduced for people on Jobseekers Allowance and Employment and Support Allowance, the justification was said to be that such measures would prompt people to search for work more actively. No evidence was cited about whether this would be the case, and no testing was undertaken to ascertain whether the theory would be borne out in practice before the system was extended nationally. A few years later, it is evident that the use of sanctions is now widespread.

The gap between evidence and practice in the support offered to people with mental health problems towards employment is stark. For people using specialist mental health services there is clear evidence that the most effective form of employment support is Individual Placement and Support (IPS). While this is being adopted by a growing number of NHS mental health services (albeit remarkably slowly given the evidence in its favour) there is little join up between IPS services and the DWP's employment programmes. For those with common mental health problems, less evidence is available but adapting the principles of IPS, offering a combination of employment support and timely access to psychological therapy, is likely to be the most effective approach. A recent feasibility study of this more supportive approach showed that a large proportion of both Jobcentre Plus advisors and unemployed people with mental health conditions were keen to give it a try, and the results demonstrated that this approach could, and did, achieve the desired results where all former programmes or the threat of sanctions had failed.

Nowhere in any evidence-based approach is the concept of conditionality or the practice of sanctioning people for not attending appointments or going for interviews for 'any' job. If anything, the contrary is the case: compulsion has no place in any effective employment programme for people with mental health problems.

Successive governments have sought to address the low employment rates of people with mental health problems. But the result has been two systems working at cross purposes: a health and social care system slowly adopting evidence based employment support, and a social security system that is much more centrally driven but whose preferred approaches are based on scant evidence and little testing. The impact on people's health, especially the large numbers of people on JSA as well as ESA who have mental health problems, is not being measured and as yet is not feeding into further policy development, despite warnings about how serious the consequences can be.